Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Japanese Multicenter Research Organization for Ossification of the Spinal Ligament, Otsu, Japan.
Spine (Phila Pa 1976). 2021 Dec 1;46(23):1621-1629. doi: 10.1097/BRS.0000000000004088.
A prospective multicenter study.
This study aims to investigate the postoperative complications of anterior decompression with fusion (ADF) for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL).
Surgical treatment for cervical OPLL has a high risk of various complications. ADF is reported to be effective for cervical OPLL, especially for massive OPLL. However, few studies have focused on the surgical complications of ADF.
We prospectively included 102 patients undergoing ADF for severe cervical OPLL with average canal occupying ratio of 49.8%. We evaluated systemic and local complications, neurological complications, and risk factors related to the postoperative complications.
Frequently observed complications included graft/ implant complications (18.6%), neurological complications (11.8%), and cerebrospinal fluid leak (11.8%). Motor palsy involving only the upper extremity was found in nine patients (8.8%), and other motor palsies involving the lower extremities were found in three patients (2.9%). None of the preoperative factors were significantly associated with the occurrence of neurological palsies, whereas the number of operated levels was a significant factor related to the postoperative graft/implant complications (P = 0.003; odds ratio, 2.112). The incidence of graft/implant complications and related reoperation increased as the number of operated levels increased (especially four levels or more). Most motor palsies were observed immediately after surgery. Of the motor palsies in the bilateral upper extremities and palsies involving the lower extremities, 85.7% showed good recovery, whereas only 40% of unilateral upper extremity motor palsies showed good recovery during the follow-up period.
In ADF for cervical OPLL, the number of operated levels was a significant factor related to the postoperative complication. Specifically, the incidence of graft/implant complications and reoperation rate increased in ADF with four or more levels.Level of Evidence: 3.
一项前瞻性多中心研究。
本研究旨在探讨前路减压融合术（ADF）治疗颈椎后纵韧带骨化症（OPLL）的术后并发症。
颈椎 OPLL 的手术治疗有发生各种并发症的高风险。ADF 被报道对颈椎 OPLL 有效，特别是对大块 OPLL。然而，很少有研究关注 ADF 的手术并发症。
我们前瞻性纳入了 102 例因严重颈椎 OPLL 而行 ADF 治疗的患者，其平均椎管侵占率为 49.8%。我们评估了全身和局部并发症、神经并发症以及与术后并发症相关的危险因素。
经常观察到的并发症包括移植物/植入物并发症（18.6%）、神经并发症（11.8%）和脑脊液漏（11.8%）。9 例（8.8%）患者出现仅上肢运动障碍，3 例（2.9%）患者出现下肢其他运动障碍。术前任何因素与神经麻痹的发生均无显著相关性，而手术节段数是与术后移植物/植入物并发症相关的显著因素（P=0.003；优势比，2.112）。随着手术节段数的增加，移植物/植入物并发症和相关再次手术的发生率增加（尤其是 4 个节段或更多）。大多数运动障碍在手术后立即出现。双侧上肢运动障碍和下肢运动障碍中，85.7%的患者恢复良好，而单侧上肢运动障碍中，只有 40%的患者在随访期间恢复良好。
在颈椎 OPLL 的 ADF 中，手术节段数是与术后并发症相关的显著因素。具体而言，四节段及以上 ADF 的移植物/植入物并发症发生率和再次手术率增加。
3 级
